Diet and Weight Management

Diet and Weight Management

Section Leader(s): Christopher Steele, MD MPH MS, Zachary Towne

 

Introduction:

The Body Mass Index is a measure of excessive weight where a index of 30 indicates obese status. In 2018, the prevalence of obesity was 42.4% and represents a serious issue for both personal and public health. Increasing obesity is associated with increased risk of all-cause mortality, along with increased risk of heart disease, diabetes, arthritis, multiple forms of cancer. All told, the estimated cost to treat obesity in the US equates to $147 billion in 2008, and those who are obese typically face medical  costs $1,429 higher than those who are not obese. Obesity and the comorbid conditions that often present themselves represent a leading cause of preventable, premature death and disease.

To help combat obesity, nutrition needs to be a part of the solution. The combination of exercise with a nutritious diet can help patients achieve a healthy weight, yet large groups of people do not achieve the proper nutrition required to maintain a healthy weight. Multiple diets exist that provide proper nutrition and help to combat obesity, these include the: DASH, Mediterranean, MIND, Ketogenic and Intermittent Fasting diets. Likewise, myplate.gov is a great source for nutritional information and guidance that patients can easily access. When considering nutrients and foods, it is also important to look at factors like the high fructose corn syrup. While some studies insist that sources of sugar do not have an impact on nutrition, recent studies like those done by Taylor et al. have shown that consumption of HFCS can increase the absorption of nutrients leading to weight gain. Tools like mobile applications can also help patients track calories and nutrients.

In this module, we will cover how to determine the appropriate nutrition for patients and identify strategies including diets that can help patients achieve a healthy weight. To accomplish this, we will also review the 5A’s counseling technique and Transtheoretical model of change.

 

Learning Objectives

By the end of this curriculum, learners will be able to do the following: 

  1. Define and describe the health risks of obesity.
  2. Describe the term body mass index and how it is calculated. 
  3. Describe the current nutrition guidance for patients.
  4. List diet options available to patients.
  5. Demonstrate nutrition counseling skills

 

Content Materials

  1. Towne, Zachary.  Diet and Weight Management. https://www.youtube.com/watch?v=Beg-s95CFRo&list=PL2YALZuw-GXCaDEvctWD4QF2diPpmjUfY&index=7
  2. CDC: Adult Obesity Causes & Consequences -
    https://www.cdc.gov/obesity/adult/causes.html 
  3. ACI Specialty Benefits: Choose MyPlate Dietary Guidelines -
    https://www.youtube.com/watch?v=-J1hmmy1OB4  
  4. Dr. Mike Evans: What’s the Best Diet? Healthy Eating 101 -
    https://www.youtube.com/watch?v=fqhYBTg73fw
  5. Body Mass Index: Considerations for Practitioners -
    https://www.cdc.gov/obesity/downloads/bmiforpactitioners.pdf 
  6. Nutrition Counseling in Clinical Practice: How Clinicians Can Do Better -
    https://jamanetwork-com.online.uchc.edu/journals/jama/fullarticle/2653762?resultClick=1 

 

Optional Reading Materials

 

References

  1. Elffers TW, de Mutsert R, Lamb HJ, et al. Body fat distribution, in particular visceral fat, is associated with cardiometabolic risk factors in obese women. PLoS One. 2017;12(9):e0185403. Published 2017 Sep 28. doi:10.1371/journal.pone.0185403
  2. Franquesa M, Pujol-Busquets G, García-Fernández E, et al. Mediterranean Diet and Cardiodiabesity: A Systematic Review through Evidence-Based Answers to Key Clinical Questions. Nutrients. 2019;11(3):655. Published 2019 Mar 18. doi:10.3390/nu11030655
  3. Rynders CA, Thomas EA, Zaman A, Pan Z, Catenacci VA, Melanson EL. Effectiveness of Intermittent Fasting and Time-Restricted Feeding Compared to Continuous Energy Restriction for Weight Loss. Nutrients. 2019;11(10):2442. Published 2019 Oct 14. doi:10.3390/nu11102442
  4. Aronne LJ. Classification of obesity and assessment of obesity‐related health risks. Wiley Online Library. https://onlinelibrary.wiley.com/doi/full/10.1038/oby.2002.203#b34. Published September 17, 2012. Accessed July 30, 2021.
  5. BMR Calculator. Calculator.net: Free Online Calculators - Math, Fitness, Finance, Science. https://www.calculator.net/bmr-calculator.html. Accessed July 30, 2021.
  6. Bray GA, Nielsen SJ, Popkin BM. Consumption of high-fructose corn syrup in beverages may play a role in the epidemic of obesity. OUP Academic. https://academic.oup.com/ajcn/article/79/4/537/4690128. Published April 1, 2004. Accessed July 30, 2021.
  7. Challa HJ, Ameer MA, Uppaluri KR. Dash diet to stop hypertension. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK482514/. Published May 19, 2021. Accessed July 30, 2021.
  8. Diet review: Mediterranean diet. The Nutrition Source. https://www.hsph.harvard.edu/nutritionsource/healthy-weight/diet-reviews/mediterranean-diet/. Published May 22, 2019. Accessed July 30, 2021.
  9. DRI Calculator for Healthcare Professionals. DRI calculator for healthcare professionals. https://www.nal.usda.gov/fnic/dri-calculator/. Accessed July 30, 2021.
  10. How to make the dash diet work for you. Mayo Clinic. https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/dash-diet/art-20048456. Published June 25, 2021. Accessed July 30, 2021.
  11. Ingraham C. The average American woman now weighs as much as the average 1960s man. The Washington Post. https://www.washingtonpost.com/news/wonk/wp/2015/06/12/look-at-how-much-weight-weve-gained-since-the-1960s/. Published April 26, 2019. Accessed July 30, 2021.
  12. Is the keto diet for You? A Mayo expert weighs in. Mayo Clinic. https://www.mayoclinic.org/is-the-keto-diet-for-you-a-mayo-expert-weighs-in/art-20457595. Published January 3, 2020. Accessed July 30, 2021.
  13. Managing overweight and obesity in adults: Systematic evidence review from the obesity expert panel. National Heart Lung and Blood Institute. https://www.nhlbi.nih.gov/health-topics/managing-overweight-obesity-in-adults. Published November 2013. Accessed July 30, 2021.
  14. Masood W. Ketogenic diet. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK499830/. Published June 11, 2021. Accessed July 30, 2021.
  15. Meyers AM, Mourra D, Beeler JA. High fructose corn syrup induces metabolic dysregulation and altered dopamine signaling in the absence of obesity. PLOS ONE. https://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0190206. Published December 29, 2017. Accessed July 30, 2021.
  16. The mind diet: Benefits, uses & studies. Noom. https://web.noom.com/blog/2020/10/the-mind-diet-benefits-uses-studies/. Published October 20, 2020. Accessed July 30, 2021.
  17. Mundi M. Is intermittent fasting good for you? Mayo Clinic. https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/expert-answers/intermittent-fasting/faq-20441303. Published April 21, 2020. Accessed July 30, 2021.
  18. Paoli A. Ketogenic diet for obesity: Friend or foe? MDPI. https://www.mdpi.com/1660-4601/11/2/2092/htm. Published February 19, 2014. Accessed July 30, 2021.
  19. Rishor-Olney CR. Mediterranean diet. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK557733/. Published April 7, 2021. Accessed July 30, 2021.
  20. Taylor, S.R., Ramsamooj, S., Liang, R.J. et al. Dietary fructose improves intestinal cell survival and nutrient absorption. Nature (2021). https://doi.org/10.1038/s41586-021-03827-2
  21. Villinger K, Wahl DR, Boeing H, Schupp HT, Renner B. The effectiveness of app-based mobile interventions on nutrition behaviours and nutrition-related health outcomes: A systematic review and meta-analysis. Obesity reviews : an official journal of the International Association for the Study of Obesity. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6852183/. Published October 2019. Accessed July 30, 2021.
  22. Wang Q, Egelandsdal B, Amdam GV, Almli VL, Oostindjer M. Diet and physical activity Apps: Perceived effectiveness by app users. JMIR mHealth and uHealth. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4840256/. Published April 7, 2016. Accessed July 30, 2021.
  23. White JS. Straight talk about high-fructose corn syrup: What it is and what it ain't. OUP Academic. https://academic.oup.com/ajcn/article/88/6/1716S/4617107. Published December 1, 2008. Accessed July 30, 2021.